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6 kids dead, 12 sick in viral outbreak New Jer

HASKELL, New Jersey -- Six children are dead and 12 others sick following a severe viral outbreak at a rehabilitation center in New Jersey.

The state Department of Health on Tuesday confirmed 18 cases of adenovirus at the Wanaque Center for Nursing and Rehabilitation in Haskell, Passaic County.

Adenoviruses usually cause mild illnesses, but the health department says this outbreak is particularly severe because it is affecting medically fragile children with severely compromised immune systems.

"This strain has been particularly associated with disease in communal living facilities," the department said in a statement. "The combination of a worse strain of adenovirus together with a fragile population has led to a more severe outbreak."

The conditions of the other 12 victims are unknown. The facility has been instructed to not admit any new patients until the outbreak ends.

"Adenovirus is very contagious virus," said Dr. Sejal Bhavsar, of Hackensack University Medical Center. "However, in these situations, they are very contagious in long-term facilities because they are often transported by sneezing and coughing, but also the particles that are passed from sneezing and coughing land on other objects. And other people go and touch it and then touch their mouths without washing their hands. That's how they can obtain the virus."

A health department team is at the facility, and an inspection team was also there Sunday. The team on Sunday found minor hand-washing deficiencies, and the department is continuing to work closely with the facility on infection control issues.

"I am heartbroken by the news that several children have lost their lives in an adenovirus outbreak at the Wanaque Center for Nursing and Rehabilitation, and pray for the full recovery of the other children impacted," Gov. Phil Murphy said in a statement. "I have been briefed by Dr. Elnahal, who has assured me that the Department of Health has recommended vital measures to enhance protections against the further spread of infection and will continue its active on-site surveillance. I am confident that the steps being taken by state and local officials will minimize the impact to all those who remain at the facility, including patients and employees."

This is an ongoing outbreak investigation.
Wanaque Center administrator Rowena Bautista issued the following statement:

"The Wanaque Center for Nursing and Rehabilitation has recently experienced some cases of the Adenovirus in its pediatric unit. The facility promptly notified all appropriate government agencies when the virus was initially identified, including the New Jersey Department of Health, The Passaic County Department of Health, The Communicable Disease Service and the Centers for Disease Control. The Wanaque Center continues to fully cooperate with these agencies and has sought out their medical guidance with respect to the virus. As a result, facility staff have diligently implemented all available infection control and prevention measures in order to protect the health and safety of the Wanaque Center's residents."

The Centers for Disease Control and Prevention said in an email that it is providing technical assistance to the state.

In the past 10 years, cases of severe illness and death from the type of infection found at the facility have been reported in the United States, said CDC spokeswoman Kate Fowlie in an email, though it's unclear how many deaths there have been.

A scientific paper cited by the CDC reported that a 1998 outbreak of type 7 adenovirus at a pediatric chronic-care facility in Chicago claimed the lives of eight patients. The 2001 paper said civilian outbreaks of the type 7 infection had not been frequently reported because of a lack of lab resources, and that the full impact on chronic-care facilities and hospitals is likely underestimated.

HASKELL, New Jersey -- New Jersey health officials say an ninth child has died in a viral outbreak at a pediatric rehabilitation center.

The state Department of Health on Sunday confirmed the latest death at the Wanaque Center for Nursing and Rehabilitation in Haskell, Passaic County, bringing the total number of cases to 25.

Officials say the latest death is a confirmed case of adenovirus and the child passed away at a hospital late Saturday night.

A health department spokesperson said all of these individuals had already been sick, so the diagnoses do not necessarily mean the virus is still spreading. But state officials say the outbreak won't be declared over until the facility can go four weeks without any new cases of people being infected.

"The strain of adenovirus seen in this outbreak is associated with communal living arrangements and known to cause severe illness," a statement read. "The department continues to work very closely with the facility to ensure that all infection control measures are being followed. An outbreak investigation, with assistance from the CDC, is ongoing."

The state became aware of the outbreak back on October 9 and has been working with the CDC, but parents of patients reached out to Eyewitness News to complain about a lack of transparency. One parent of a sick child said she only learned of the outbreak by watching the news and that they were never told about the severity of the situation. She said a nurse downplayed the situation, saying her daughter had a fever and was given medication due to "a little virus going around" similar to the common cold.

Meanwhile, the parents of a 16-year-old girl who died are trying to come to grips with their loss. Kristine Poulos said the girl was diagnosed with adenovirus on October 5 after she was transferred to St Joseph's Hospital for treatment.

"I'm angry," Poulos said. "I think what it is, I need to know more information. I like facts."

After critical care at St Joseph's, the girl was transferred back to Wanaque, where she died Tuesday morning.

"I just want to know what happened," Poulos said. "She's not coming back."

The Wanaque Center is also offering professional grief counseling to anyone impacted.

Adenoviruses usually cause mild illnesses, but the health department says this outbreak is particularly severe because it is affecting children with severely compromised immune systems.

"This strain has been particularly associated with disease in communal living facilities," the department said in a statement. "The combination of a worse strain of adenovirus together with a fragile population has led to a more severe outbreak."

The conditions of the other victims are unknown. The facility has been instructed to not admit any new patients until the outbreak ends.

"Adenovirus is very contagious virus," said Dr. Sejal Bhavsar, of Hackensack University Medical Center. "However, in these situations, they are very contagious in long-term facilities because they are often transported by sneezing and coughing, but also the particles that are passed from sneezing and coughing land on other objects. And other people go and touch it and then touch their mouths without washing their hands. That's how they can obtain the virus."

A health department team remains at the facility, and an inspection team was initially there Sunday. The team on Sunday found minor hand-washing deficiencies, and the department is continuing to work closely with the facility on infection control issues.

"I am heartbroken by the news that several children have lost their lives in an adenovirus outbreak at the Wanaque Center for Nursing and Rehabilitation, and pray for the full recovery of the other children impacted," Gov. Phil Murphy said in a statement. "I have been briefed by (Health Commissioner) Dr. (Shereef) Elnahal, who has assured me that the Department of Health has recommended vital measures to enhance protections against the further spread of infection and will continue its active on-site surveillance. I am confident that the steps being taken by state and local officials will minimize the impact to all those who remain at the facility, including patients and employees."

"The Wanaque Center for Nursing and Rehabilitation has recently experienced some cases of the Adenovirus in its pediatric unit. The facility promptly notified all appropriate government agencies when the virus was initially identified, including the New Jersey Department of Health, The Passaic County Department of Health, The Communicable Disease Service and the Centers for Disease Control. The Wanaque Center continues to fully cooperate with these agencies and has sought out their medical guidance with respect to the virus. As a result, facility staff have diligently implemented all available infection control and prevention measures in order to protect the health and safety of the Wanaque Center's residents."

The Centers for Disease Control and Prevention said in an email that it is providing technical assistance to the state.

In the past 10 years, cases of severe illness and death from the type of infection found at the facility have been reported in the United States, said CDC spokeswoman Kate Fowlie in an email, though it's unclear how many deaths there have been.

A scientific paper cited by the CDC reported that a 1998 outbreak of type 7 adenovirus at a pediatric chronic-care facility in Chicago claimed the lives of eight patients. The 2001 paper said civilian outbreaks of the type 7 infection had not been frequently reported because of a lack of lab resources, and that the full impact on chronic-care facilities and hospitals is likely underestimated.

Adenoviruses are usually spread from an infected person to others through

close personal contact, such as touching or shaking hands
the air by coughing and sneezing
touching an object or surface with adenoviruses on it, then touching your mouth, nose, or eyes before washing your hands
Some adenoviruses can spread through an infected person’s stool, for example, during diaper changing. Adenovirus can also spread through the water, such as swimming pools, but this is less common.

Sometimes the virus can be shed (released from the body) for a long time after a person recovers from an adenovirus infection, especially among people who have weakened immune systems. This “virus shedding” usually occurs without any symptoms, even though the person can still spread adenovirus to other people.

Adenoviruses are a family of viruses that often cause mild illness, particularly in young children
the particular strain of adenovirus (#7) in this outbreak is affecting medically fragile children with severely compromised immune systems. The strain has been particularly associated with disease in communal living arrangements and can be more severe.

VOORHEES, N.J. (WPVI) -- Patients at a second New Jersey pediatric facility have been found to have a respiratory virus, but authorities say it's a different strain from the one linked to nine deaths.

The state health department says there are four confirmed adenovirus cases among pediatric patients at Voorhees Pediatric Facility in Camden County. But preliminary tests have ruled out Type 7, the strain linked to ten deaths at the Wanaque Center for Nursing and Rehabilitation.

New Jersey health officials are sending infection-control teams to four long-term pediatric centers and a hospital to assist with training amid the viral and bacterial outbreaks that have killed a combined 10 people.

One of the deaths at the Wanaque center was a young adult. A premature baby died amid bacterial infections at the Newark hospital this month.

Yet it would not be until Oct. 9 -- and after the death of two children -- when the Wanaque Center for Nursing and Rehabilitation notified the state Health Department of a viral outbreak inside the long-term care facility in northern New Jersey. And then another 12 days before state inspectors walked in the door.

The devastating adenovirus outbreak at the Wanaque Center in Haskell has so far led to the deaths of 10 children and infected 19 more. How the outbreak began remains unknown.

But an examination of how the outbreak unfolded and spread rapidly has raised questions over why state health officials waited two weeks before deploying a team to see for themselves how Wanaque was managing the crisis.

The state's response will be part of what the state Senate Health, Human Services and Senior Citizens Committee will examine when it holds a hearing on Dec. 3 to discuss the outbreak, said Sen. Joseph Vitale, the committee chairman said.

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers allege

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers allege

"We will ask as many questions as we are able to, but this will be one of them," said Vitale, D-Middlesex.

"We want to know when it was reported, how the department responded and how the facility responded," Vitale said, adding he wanted to be cautious "until we know all of the facts."

"No doubt we are all concerned about this, and as a layperson, I say something is amiss here," he said.

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers alleg

Death stalked the Wanaque center. Still, they delayed sending kids to the hospital, workers alleg

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Wanaque notified the state and local health departments about the outbreak after business hours on Oct. 9., according to Health Department spokeswoman Donna Leusner.

"The state immediately counseled the facility on infection control protocols, to be implemented immediately," Leusner said.

The next day, the department's Communicable Disease Service -- along with the U.S. Centers for Disease Control and Prevention and the local health department began working with Wanaque to recommend infection control practices, she said.

The state dispatched two registered nurses from its Health Facilities, Survey and Field Operations office on Oct. 21 and conducted a surprise inspection. A state inspection specialist has remained on site.

The state conducted a second surprise inspection on Friday after a report by NJ Advance Media citing workers at the Wanaque Center who alleged that administrators delayed sending critically ill kids to the hospital because they did want to lose Medicaid funding if a pediatric bed went empty.

The decision to wait two weeks before sending in state health employees was based on the science of allowing one incubation period to elapse to see whether Wanaque's handling of the outbreak was working, Leusner said.

The incubation period of the adenovirus virus is two weeks, the department said.

"It would have been impossible to determine that an on-site presence could have been useful before an incubation period's worth of time," health department spokeswoman Dawn Thomas said.

"It should be understood that while on-site inspections, infection control consultations and the daily monitoring that are in place now are useful for information-gathering and determining possible enforcement, they do not have direct impact on containing the spread of the virus or preventing harm to patients," Thomas said.

"Containing the virus ultimately depends on facility management and clinical staff following these protocols under all circumstances, for every patient, and Department of Health is taking every action it can to hold the facility accountable for this," she added.

"The Commissioner believes that DOH staff responded appropriately at each time point, given the information we had," she said.

Adenovirus is actually a group of viruses that are rarely fatal. They mimic symptoms of the flu and common cold, often attacking the respiratory tract, but can also cause gastroenteritis and conjunctivitis. They tend to affect infants and children, according to the Centers for Disease Control and Prevention.

Illnesses from the virus are usually mild and people typically recover in a matter of days. But in some cases, infections from adenovirus can be potentially life-threatening, particularly those with weakened immune systems.

All of the pediatric patients at Wanaque Center are medically fragile. Most need ventilators to help them breathe. Some had severe birth defects and significant health problems.

Why these died, however, remains puzzling to some.

"These kids were really fragile and severe adenovirus certainly can be fatal," observed David Cennimo, an epidemiologist at University Hospital in Newark and a professor of medicine at Rutgers University Medical School. "It's a bad respiratory illness and you can end up on a ventilator. But these kids were already on a ventilator and I wonder why they couldn't support them through this."

Not involved directly or knowing specifics about their cases, he said he wondered if there were secondary infections. There are many unanswered questions, he added.

State health officials, while they continue to investigate, said they may never know the answer to how the virus spread.

"It's impossible for us to know what exactly were the factors related to the spread," said Christina Tan, the state's epidemiologist who heads the health department's Communicable Disease Service. "There are many factors."

Adenovirus is not an airborne threat. It does not get spread through a building's heating and ventilation system, like Legionnaire's Disease, explained Tan. Rather, the virus moves through respiratory droplets or contact.

The state inspects these facilities every nine to 15 months, Leusner said.

The Wanaque Center had been repeatedly cited for deficiencies in handwashing and infection control, both before and after the outbreak, according to state and federal inspection reports.

During an inspection last month, the state said there were germicidal disposable wipes, sanitizers, masks, gloves, and gowns available on every wing, and mostly in every room for the staff and visitors to use prior to entering the room. The report said there were also guidelines regarding adenovirus for visitors visible in each room, warning visitors not to visit if they are sick, and observed staff cleaning the rooms with germicidal cleaning solutions.

But the report noted deficiencies in handwashing procedures, where members of the staff did not wash their hands long enough.

Washing hands is imperative. Not a quick rinse, but for at least 20 seconds. They teach health care professions to sing "Happy Birthday" to themselves about twice. At Wanaque Center, state inspectors found that some nurses were not getting even through the first verse, in terms of timing.

Cennimo said there was a high likelihood that the only way it would have moved from one bed-bound patient to another was by someone who was caring for the kids.

"I would be concerned that whoever was caring for the kids was the contact vector between them," Cennimo said.

Vitale, the health committee chairman, said the he hopes to find out whether the outbreak spiraled because of human error or systemic weaknesses. Maybe it's both. he said.

"These children are medical fragile and depend on other people for their survival," Vitale added. "It shouldn't have happened to this degree. One child gets sick and maybe two, but this many?

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